cm 2 /m 2 vs mechanical prosthesis ..

In analyzing TE rates after cardiac surgery, one has to balance sample size with data completeness. Our series is small, and careful analysis selected a limited number of a priori variables potentially linked to TEs to limit the possibility of statistical bias. Fortunately, our entire experience post- mitral surgery has already provided critical points in term of the superiority of tissue substitutes (repair or bioprostheses) and the lack of association of atrial fibrillation to TE post-mechanical MVR. Thus, the main issue to resolve focuses on anticoagulation quality, for which our series provides unique information. Furthermore, in comparing valve substitutes multicenter studies with their extreme variability in TE rate estimates are seriously limited, and our findings of excess TE rates in patients who have undergone MVR with ball prostheses concur with those of more uniform, small, single-center studies., Thus, despite its relatively small size, our population-based series with complete data contains sound statistical conclusions and novel information.

of a bileaflet mechanical heart valve prosthesis"

Surgical Valve Replacement (Bioprosthetic vs

We compiled a complete record of all residents of Olmsted County, MN, who underwent mechanical MVR between 1981 and 2004, for all TE, bleeding episodes, and international normalized ratios (INRs) measured from prosthesis implantation.

Surgical Valve Replacement (Bioprosthetic vs ..

One patient denied a prosthesis reimplantation. In this case, the patient started to increase weight-bearing on the leg 3 months after spacer implantation. 13 months later, X-rays revealed an asymptomatic acetabular fracture without any spacer dislocation. At a follow-up of 52 months the patient is still free of any infection signs and has no complaints at an almost free range of motion.

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LV EF,,, and MVR,, are recognized risk factors for TE after valve replacement that were also observed in our study. Atrial fibrillation precipitates TEs,, with tissue MVR but not mechanical MVR, which is similar to the results of the present study. Prosthesis type as a TE predictor is controversial.,,,,, These uncertainties stem mostly from differences in TE definition between centers, and uniform TE definition may be an advantage of single-center studies. Recent prostheses are considered less thrombogenic than first-generation prostheses.,, However, proof of definite differences in TE rates between various types of prostheses is scant and disputable. The concept of a higher thrombogenicity for ball valves, has led to the European guidelines recommendation of higher INRs as a presumed compensation for higher thrombogenicity. This recommendation should be reconsidered, as more intense anticoagulation in patients receiving MVR with ball prostheses did not compensate for higher thrombogenicity. Furthermore, higher intensity anticoagulation never reduced TEs, complicating the use of mechanical prostheses.,, The occurrence of excess TEs, particularly stroke, with use of a ball valve in MVR concurs with the results of small single-center studies, and is quite considerable (8.5 vs 3.1 per 100 patient-year, respectively; p was a life saver in its time and has economic advantages for developing countries, but it carries with it an unacceptable TE rate and should be retired from use worldwide. Safer valve substitutes should be available with similar cost-effectiveness. The management of the MVR ball valve in place is more conjectural. Whether target anticoagulation intensity should be an INR of 2.5 to 3.5,,,– or whether an INR of 2 to 3 is also acceptable cannot be ascertained from our data. The absence of a link to the INR-average TE rate in our study may be an incentive for recommending an INR of 2 to 3. A lower goal would reduce variability and minimize bleeding. Finally, the recommendation of using low-dose aspirin in combination with anticoagulation is not affected by our study,, and there is no rationale to alter this guideline.

Compare Mechanical Loosening Of Hip Prosthesis …

In this study, six gloves, three PVC and three silicone, by one manufacturer were tested. The outcomes may vary among other brands and types. However, it is unlikely that such variations will give a totally different outcome. The variations in the results among the joints and fingers were small, whereas the variations between the gloves were large. Both gloves were identical in size, shape, and texture. The only parameter that differed between the gloves was the material. This study clearly shows that the glove material has a considerable effect on the mechanical performance of a cosmetic glove and on the energy requirement of a prosthetic hand. The results are in line with the design choice of the designers of the i-limb and Bebionic. They used silicone when they designed special multilayered, reinforced gloves for these new hands.

Mechanical or Biologic Prostheses for Replacement of Aortic ..

This population-based comprehensive study of anticoagulation and TE post-MVR shows that, in these closely anticoagulated patients, anticoagulation intensity was highly variable and not associated with TE incidence post-MVR. Higher anticoagulation intensity is linked to higher variability and, thus, to bleeding. The MVR-ball prosthesis design is associated with higher TE rates notwithstanding higher anticoagulation intensity, and its use should be retired worldwide.

Achieved Anticoagulation vs Prosthesis Selection for ..

The quality of anticoagulation is generally considered important in TE prevention after mechanical valve replacement. While high-visibility studies suggested that TEs were exceptional with optimal anticoagulation, TEs remain a major problem after mechanical MVR, and their link to anticoagulation quality remains controversial.,,– Many studies,,,,,, have analyzed convenience samples of mechanical MVR, but incomplete or sparse anticoagulation data have been usual. Furthermore, anticoagulation regimens were assessed by the intention to treat and not by actual achieved results. Hence, clinical guidelines,,– acknowledge scant evidence supporting anticoagulation recommendations and are remarkably discrepant (European vs American guidelines) regarding the thrombogenicity of mechanical prostheses and the tailoring of the goals of anticoagulation to patient and prosthesis.,,,

Best-known and most implanted mechanical bileaflet valve; ..

Bioprostheses have become increasingly popular for aortic valve replacement (AVR) in recent years, but mechanical valves are still the standard choice, especially for younger patients. The aim of this study was to assess the very long-term outcomes in Japanese patients who underwent AVR with St. Jude Medical (SJM) mechanical valves.